In which, the gynecologist gets ALL UP in my bizness.

FAIR WARNING: As should be obvious from that ^^^ title, this post is about a recent gynecological examination I underwent (due to my ongoing experiences with vaginal pain). Please decide whether to read on or to click away accordingly.

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A Bit of Background

Those of you who read me on the reg are already familiar with the basics; those of you who are new here or who only stop by intermittently may appreciate a broad-strokes background against which to paint their own picture of the most recent happenings in this arena.

SO

Once upon a time, I had a pretty high sex drive. I have (had?) PCOS, one of the typical symptoms of which is a high testosterone level. Since testosterone is the hormone that drives sexual response in both males and females, and since my testosterone was high… Well, my sex drive was high. This meant I desired sex — was interested in it, was ready for it (on very little notice and with barely any stimulation¹) — on a pretty high level, and that I participated in sex/ual activities pretty frequently.

Then I turned 40.

What began as “taking longer to respond” became, over time, a loss of interest. And then, when that interest *did* appear, any sexual contact involving penetration became painful.

Which pretty much put me off sex entirely by the time I was 43.

My initial conversations with doctors about the declining-interest and beginning-pain issues were met with the standard response of “use lube.”

Well, I’ve been using lube since I was 18. Lack of lubrication is NOT the issue. (Though it’s true my tissues are a bit dryer than they used to be, which certainly doesn’t help the situation.)

Then COVID hit. Doctors offices were closed.

And you can’t very well have a gyno appointment when a physical examination is an impossibility.

Which meant that — at age 46 — when I finally got to see my (new) (female) doctor recently, all of this came to the forefront.

The result of my conversation with her was that I was referred to Women’s Health.

The Exam

Once in the gynecologist’s office, I told my story as succinctly as possible. I gave (non-lurid) examples, I referred to pieces of my anatomy, I demonstrated the action of the speculum² by placing one curved hand inside the c-shaped opening I created with another. I told the GYN that the reason I was there was because my PCP thought pelvic floor therapy might be a good option for me but she also felt like there might be another/different issue going on with my cervix. “And so,” I finished, “here I am.”

Well, there’s nothing wrong with my cervix.

(Whew?)

There *is* something wrong with my pelvic floor.

Which was determined as follows:

GYN: I’m going to press my fingers inside you and I need you to tell me what and how it hurts.

Me: Great.³

And can I just say that having a strange female slide her fingers up inside and ask me how I was feeling — while I was trying to think about what I tend to feel during penetrative sex — created a strange dissonance? Not only were we having an open, fairly casual conversation about sex, but she was mimicking the motions/movements I would typically experience during sex… Which was NOT SEXY… And it was all a bit surreal.

A n y w a y

That aside…

She slid one finger shallowly into my vaginal opening. That didn’t hurt.

She pushed that finger further up inside me, straight up. It didn’t feel good but it didn’t feel bad either. It was familiar. Somewhat dissonant in the physioemotional realm but not painful.

Then she moved that fucking finger.

And she’s lucky I didn’t un-spread my knees and kick her in the goddamn face.

And then she moved it again.

I gave her answers to the “Does it hurt?” question through clenched teeth.

And again.

At which point I really wished there was a sharp instrument nearby that I could grab and stab her in the head with.

And then she took her fingers away.

I breathed.

She said, “You would definitely benefit from pelvic floor therapy.”

Pelvic Floor Therapy

Having long heard that kegels are required for re-toning the vaginal muscles after childbirth and that weak pelvic muscles can contribute to urinary incontinence in women, I always figured that ‘exercises’ involving those muscles were not something I needed. And honestly, when the concept was first introduced to me — as Pelvic Floor Exercises — at this juncture, I was pretty skeptical. Because doesn’t exercising those muscles serve to strengthen them? I don’t need them strengthened. If anything, they are already too strong. They are essentially a saddle full of Atlas muscles. That’s the problem, right?

Well, yes and no.

Those muscles are tight. Incredibly, painfully, and — because of the length of time I’ve been dealing with this — chronically tight.

But just like when you exercise muscles elsewhere in your body, those muscles — through the workout you give them — go through a re-learning process of adaptation and movement. Which is essentially what the ‘exercise’ portion of ‘pelvic exercise’ is supposed to help my pelvic muscles do. They will relearn how to move, relax, and respond.

The physcial therapy portion of the program — physio, for some of my readers — is a bit of a mixed bag: massage therapy, biofeedback, and directed exercise.

So I agreed to try it.

I don’t yet have an appointment, but my referral has been sent. My GYN is optimistic that I should be able to begin this physio experiment before the end of June.

Why bother?

It’s a legit question, right?

Like… I don’t have peeing-my-pants problems, I kinda don’t care much about sex at this point so therefore don’t care whether penetrative sex is a thing.⁴ So if this is only about painful sex and I can do without sex all together… Why bother?

Well, outside of the marital-intimacy issue, there are other factors at play here. My body used to behave one way. That ‘one way’ has radically changed. Typically — in any other form of human health — a radical change (for the negative) is examined closely. It is diagnosed. It is treated. For centuries, women’s health issues have gone undiagnosed. Unrecognized, untreated. So knowing that this is a Real Thing, that it’s a Health Issue, that — rather than being ignored, condescended toward, or otherwise less-than‘ed — it is diagnosable and treatable… That feels important to me.

Also, that saddle of muscles is at the center of my personal gravity. There are very basic functional issues that are supported by the pelvic floor. But there are also things like core strength and posture to take into consideration. (I need both.) And just like oral health is not separable from overall health, neither is reproductive health⁵ a separate (or unimportant) issue.

So I’m going to go forward with this because I believe my health is important.

Because I believe my vaginal health is important.

And because I believe that sexual health — individually, physically — and sexual relationship health — healthy sexual partnerships — both matter.

We’ll see how it goes.

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¹Think: 13-yr-old boy looking at just one centerfold from his dad’s porn mag stash

²I could not for the life of me remember what the damn thing was called! Speculum. Speck.You.Lum. For frick’s sake.

³Not great.

⁴I *do* care, in that I believe it’s an important form of intimacy in my marital relationship. But also: I don’t care.

⁵Reproductive health is a fraught term. I get that. I, for one, have no intentions of reproducing. So call is ‘sexual health’ if you prefer.